Collaborative work fueled the success of ACA enrollment

The initial enrollment period for the Health Insurance Marketplace has officially ended. Nationally, more than 8 million individuals signed up for private insurance in the Health Insurance Marketplace while more than 3 million young adults were able to gain coverage by being able to stay on their parents’ plan. In addition, more than 4.8 million more individuals were enrolled in Medicaid and CHIP (Children’s Health Insurance Program) from October 1, 2013 through the end of March 2014. It is clear that the Affordable Care Act (ACA) is working and has given many Americans peace of mind and security in knowing their family will be protected from high, unexpected healthcare costs.

Around 357,584 North Carolinians enrolled in marketplace plans between Oct. 1, 2013, and April 15, 2014. There was a 78 percent growth in number enrolled since March 1: 200,546 to 357,584. This increase can be attributed to improvements in the website as well as the state’s specific coordination strategies:

-- The NC Navigator Consortium, a group of 11 non-profit organizations working collaboratively under a single grant (fourth largest Navigator grant in the country).

-- A statewide coalition that includes a variety of partners who have met frequently since January 2013 to discuss how best to implement the new marketplace in North Carolina.

-- Creating one statewide phone line individuals can call to schedule in-person appointments for enrollment assistance.

In Durham, the planning for ACA outreach and enrollment efforts began in March 2013 with the coordination of the Durham ACA workgroup by Project Access of Durham County and the Access to Care Committee of the Partnership for a Healthy Durham. The focus of this group, comprised of representatives from many Durham agencies, is to educate about the ACA, provide individual assistance to help individuals enroll in insurance plans through the marketplace, and to increase collaboration among all agencies involved with marketplace and Medicaid enrollment.

Ricardo Correa, outreach and enrollment coordinator for Lincoln Community Health Center, knows first-hand the importance of community collaboration. He acknowledges that “collaboration helped greatly with tasks that the clinic couldn’t have accomplished with their own resources.” Lincoln Community Health Center utilized extended hours of service. From October 2013 to March 2014, the clinic reached 5,599 individuals and enrolled 1,230 individuals into a qualified health plan.

In-person assisters will continue to engage individuals through outreach to identify those persons who may be eligible for Medicaid/CHIP or a Special Enrollment Period (SEP), a time outside of open enrollment during which an individual or their family may sign up for health coverage.

Individuals are eligible for a SEP if they have experienced a qualifying life event like having a baby, getting married, or losing health coverage from an employer or Medicaid/CHIP.

This SEP lasts 60 days from the triggering event.

To check eligibility, individuals can go online to the federal website at www.HealthCare.gov or call the federal call center at 1-800-318-2596.

Since 24 States have not expanded Medicaid, including North Carolina, 5.7 million individuals will be uninsured in 2016. Additionally, due to residency status, an unknown number of undocumented immigrants are ineligible to purchase an insurance plan in the Health Insurance Marketplace. As a result, Durham will continue to be responsible for and provide health care services to these individuals and many more. Primary care will still be provided through Lincoln Community Health Center, Samaritan Health Clinic, CAARE clinic and Duke Outpatient Clinic while specialty care can be obtained through Project Access of Durham County on a referral basis from Lincoln Community Health Center. The Durham County Department of Public Health will continue to provide health care services to Durham’s residents as well. The collaborative work at the state and local levels is an example of how the community can come together to assist residents with finding affordable health insurance options under the ACA.

Krystal Holman is with Project Access of Durham County and Partnership for a Healthy Durham. The Partnership for a Healthy Durham continues to support increasing access to health insurance in Durham. For more information, www.healthydurham.org.